San Francisco Chronicle - Friday, July 12, 2002
Sabin Russell, Chronicle Medical Writer

Clinton's first stop on arrival at the 14th International Conference on AIDS was a visit to the kickoff of a global media campaign to prevent HIV, where he held court before MTV's cameras with teens from 25 countries who came to Spain to talk about AIDS.

The former president also urged developing nations around the globe to "cut a deal" for the best price on AIDS drugs, including generics that are produced without agreements from patent holders.

"If the deals are unsatisfactory, go to Brazil or India," Clinton said. He also stressed: "This needs to be done, and done now."

New studies by the United Nations and the Kaiser Family Foundation in Menlo Park underscore the peril that AIDS poses to an entire generation. This generation is coming of age during an epidemic that is predicted to kill 68 million by 2020.

"I am not really scared of AIDS, because I know how to protect myself, but I am scared for my country, for the people still living in darkness," said Tina Magagane, a bright 16-year-old from Acornhoek in the rural north of South Africa.

It was Magagane who asked the former leader of the free world why the United States could raise $40 billion in a matter of days for the war against terrorism but not give what protesters demand to fight AIDS.

"It was an extraordinary feeling," she said of her moment in the spotlight.

'AN EPIDEMIC DRIVEN BY YOUTH'

A Kaiser Foundation analysis of U.S. Census data forecasts that the global total of people age 15 to 24 living with HIV infection will increase more than 73 percent -- to 21.5 million from today's 12.4 million -- by the end of this decade.

"HIV is an epidemic driven by youth," said Drew Altman, president of the foundation. If the projected infection rates hold true, he said, "this will lead to a staggering number of deaths among young people."

There is disturbing evidence of a failure to reach teens in developing countries with even the most basic AIDS prevention messages -- that HIV is a sexually transmitted disease, and that the best way to prevent it, barring abstinence, is through condoms.

A Mozambique study found that 74 percent of teenage women were "unaware of any way to protect themselves from HIV."

Stephen Lewis, the United Nations' special envoy on AIDS in Africa, said recent visits to the continent had brought home to him just who was getting hit the hardest. "If I were a young person, I would be pretty depressed by what is coming out of Barcelona," he said.

FEMALES ARE INFECTED THE MOST

A recent World Health Organization report found that of 8.6 million young people age 15 to 24 infected with the AIDS virus, 67 percent were women and girls. "The greatest price on the planet being paid for this epidemic is being paid by the women and girls of Africa," Lewis said. "It is a nightmare."

Dozens of studies around the globe have shown that infections are clustered among girls age 15 to 24 and among the men who infect them, often 10 to 20 years their senior.

HIV does not have to infect to inflict a terrible toll on the young. UNICEF reported Wednesday that 25 million children would lose at least one parent to AIDS by the end of this decade, compared with the 13.4 million AIDS orphans today. U.N. officials define an orphan as a child younger than 16 who has lost one or both parents.

"This is one of the most shocking reports released at this conference," said Peter Piot, executive director of UNAIDS, the Joint United Nations Program on HIV/AIDS. The skewing of AIDS against the young suggests a strategy:

Reach the young with prevention messages, change their behaviors and alter the course of a world catastrophe.

"What happens among young people will define the shape of this epidemic," said Dr. Helene Gayle, director of AIDS programs for the Bill and Melinda Gates Foundation.

REACHING YOUTHS ON THEIR TERMS

Thursday's video extravaganza with Clinton is part of a new media campaign designed to reach the young with AIDS prevention messages. The MTV program "Staying Alive" is part of a prevention strategy that uses modern marketing techniques -- slick ads, edgy entertainment and expensive public relations efforts -- to sell safer sex to teens.

Another example is Kaiser's LoveLife program in South Africa, the largest HIV prevention program for youth in the world. Teenagers do not respond well to lectures or scare tactics, said foundation president Drew Altman.

"But they are heavily influenced by other young people, and are heavily, heavily influenced by the media," he said. "It is a central element of youth culture."

The program is costly, about $30 million a year. But the goal is to create a shift in behavior among South African youth that, if calculations are correct, would cut the infection rate among that group in half within five years.

"If we can bring about a moderate shift, from high-risk to moderate-risk behavior, we will substantially change the course of the epidemic," said Dr. David Harrison, LoveLife's chief executive.

E-mail Sabin Russell at srussell@sfchronicle.com.
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